Hi my name is shosh Goldman. I just saw a mom and baby who seem to
have a lot going on and with the moms permission I wanted to get your
feedback on how to properly manage this case.

I just saw a mom and baby. Background: Mom is 26 first baby no
complications in pregnancy or delivery, no medical history in mom.
Baby is now 2.5 months old and was breast feeding fine with clear
preference to moms right breast as left has slight over active milk
ejection reflex. Baby has milk soy protein intolerance - mom is on a
diet but not avoiding soy lecithin or oil. Mom said babies stool is
still mucusy and has microscopic blood more when she eats bread so she
just took wheat out of her diet as well. Baby also has reflux and is
on Zantac . Peds told mom baby has some thrush , moms base around
nipples are red slight shine to them but she is in no pain just some
itching, peds said don't have to treat them, but gave cream anyway.
They used the cream for a few days but then mom stopped because she
thought the taste was effecting breast feeding for them. Baby did not
gain much in the last week but was born 8 lbs 1 oz and at 2.5 months
is slightly below 14lbs. Baby recently started going to babysitter 2-3
days a week and gets 5 oz bottles there. Mom pumps between 6-3 oz per
pumping session while seperated.

I was consulted because baby came off a growth spurt into a nursing
strike since friday.  Mom is frustrated and just wants baby to nurse
at the breast. (In observation the baby's tongue is white) the baby
latched ( mom said the best of the day) for about 15 minutes on
preferred side came off on his own the baby transfered 1.5 oz . he
wanted more but refused to latch -turned his head away, crying,
looking for food but not willing to latch. Mom was against doing skin
to skin from the start of consult, I re suggested it at this point.
She wasn't into it, I tried to get him to suck on my finger he would
not but took a pacifier to calm down. Mom agreed to try latching in
the tub, I suspect the refusal may have to do with reflux ( but that's
just a guess) we latched the baby on the less preferred left side in
the bath he stayed on for about ten minutes of active feeding then
came off. Mom wanted to try relatch out of bath in upright position
but he only did this for a few minutes then refused the breast. She
did skin to skin at this point and he was rooting around but refused
to latch.   At that point mom offered a bottle. Even with the bottle
baby was visibly uncomfortable by ( reflux?) and needed frequent
burping. Mom gave 4+ oz because she thought baby was still hungry.
He seemingly only latches when he's starving and then protests.
Mom is not washing bottles / pump parts just daily sterilizing.

I left mom with giving her a nurse bottle pump routine. I suggested
try to give an ounce and then try relatch ( he did briefly while I was
there after first ounce).  Encouraged her to do bath feeds skin to
skin, laid back/ upright nursing ( modified football or cross cradle)
and to try latching while he's sleeping or drowsy, or to try latching
for comfort sucking if he will after he's fed.  Encouraged her to wash
all bottle pump with soap and vinegar.   Follow up with md about the
thrush. Encouraged her babies go on strike but usually once problem
gets better they come back to breast.

Let me know
Thanx
Shosh Goldman RN IBCLC NYC

             ***********************************************

Archives: http://community.lsoft.com/archives/LACTNET.html
To reach list owners: [log in to unmask]
Mail all list management commands to: [log in to unmask]
COMMANDS:
1. To temporarily stop your subscription write in the body of an email: set lactnet nomail
2. To start it again: set lactnet mail
3. To unsubscribe: unsubscribe lactnet
4. To get a comprehensive list of rules and directions: get lactnet welcome